Nursing Diagnosis

This week, I will give you five nursing diagnosis for bronchitis.

1)  Ineffective airway clearance related to increased mucus production.  Thick mucus production is a signature sign and symptom of bronchitis, especially chronic bronchitis.  Our goal for patient would be to clear airway effectively with nursing intervention such as drinking 3 liters of water a day to thin out mucus.

2)  Activity intolerance related to ineffective ventilation and oxygenation.  Having constant shortness of breath and coughing while moving around are the major complaints from patients with bronchitis.  This is significant because it means you can't take a shower, grocery shopping, walking down the street without catching your breath or having trouble breathing.  Our nursing goal for the patient would be to tolerate daily activities without trouble breathing with nursing intervention such as daily activity such as short distance walking with time increment as tolerated.  If patient is in the hospital, maybe he/she would walk around the unit once a day and distance and frequency would increase as the patient can tolerate.  

3)  Anxiety related to changes in health status.  It is scary to have bronchitis because you can't breathe properly.  It can be overwhelming to adjust to your new health condition.  You can't live your life like you used to before you have bronchitis.  If you have chronic obstructive pulmonary disease (COPD), you will not be cured from it.  Treatment would only treat your symptoms which do not go away.  Our nursing goal for patient would be able to cope with current medical condition with friends and family with nursing interventions such as education about the illness, education about local support group, etc.  

4)  Ineffective breathing pattern related to bronchoconstriction and excessive mucus.  When you have bronchitis, your bronchi would constrict and thick mucus would be released.  It can clog up your airway making you suffocate.  Some patient with COPD with acute exacerbation would require suctioning and ventilation to breathe and to maintain a patent airway.  Our goal would be to breath effectively by using pursed-lip breathing technique and sitting in a tripod (semi-fowler) position.  It will be the nurse's responsibility to teach the patient these techniques and to practice with the patient.

5)  Acute pain related to inflammation in pleura (the thin sheet mucous tissue that wraps around your lungs).  You will hurt whenever you breathe.  Our goal is have patient's pain manage at a comfortable level per patient's report.
  

Actual/Potential	related to	plan/outcome	nursing intervention
Actual pain	related to inflammation in pleura	manage pain/ patient will report 3/10 pain by the end of shift.	offer routine/prn pain medication accordingly, assess patient’s pain level during hourly rounds.

Reference:  

NCP NANDA. (n.d.). Retrieved February 26, 2015, from http://ncpnanda.blogspot.com/2013/02/9-nursing-diagnosis-for-bronchitis.html

(n.d.). Retrieved February 26, 2015, from http://faculty.mu.edu.sa/public/uploads/1380604673.6151NANDA 2012.pdf

Should I care?

Hopefully by now, you have a pretty good idea about diagnosis, pathology, and treatment for acute and chronic bronchitis.  This week I will talk about ways nurse provide care for people with acute or chronic bronchitis.  First of all, I highly recommend you to visit the homepage of the American Lung Association.  It provides a lot of information such as different types of lung disease, up to date research information about each disease, and diagnosis and treatment for the diseases.  Since most of acute bronchitis is caused by a virus, you don't need antibiotics to treat it.  It would go away on its own.  I would recommend my patients to wash their hands with soap and warm water as often as possible, monitor for cough, maintain a nutritional diet, gets as much  sleep as possible, do not smoke, stay away from any irritants/ allergens that might trigger your asthma (because you don't want any complication with your bronchitis), have your rescue inhaler ready in case you need it, and pay attention to your vital signs such as temperature, pulse, respiration rate, and blood pressure.  You should seek medical help if your vital signs are not normal, you feel worse and your cough worsens.
As your nurse, I will pay attention to all the items listed above and report any changes to your provider.

For chronic bronchitis, also known as COPD (Chronic Obstructive Pulmonary Disease), my approach of care as a nurse would be slightly different. I recommend you to check out this website which breaks down different ways and approaches to take care of someone with COPD with tables.
http://nurseslabs.com/10-chronic-obstructive-pulmonary-disease-bronchitis-nursing-care-plans/
In addition to the approaches discussed in the link above, I would highlight the importance of clearing your secretion from your airway.  For most patients, this is a challenge.  I would recommend my patient to sit up, encourage fluid intake, take their medication according to prescription, and take deep breaths or use the incentive spirometer.  If coughing isn't enough to clear the secretion, suctioning through the nose or airway of the patient is necessary.  I would explain the steps clearly to the patient before execution.  Definitely monitor vital signs, signs and symptoms of infection, breath sounds, and provide support for the patient since this is a stressful disease without a cure.



References:
EHS: Nursing Diagnosis Care Plans, 4/e - Airway Clearance, Ineffective. (n.d.). Retrieved February 20, 2015, from http://www1.us.elsevierhealth.com/MERLIN/Gulanick/archive/Constructor/gulanick03.html

Hart, A., Nurse Practitioner: 18 September 2014 - Volume 39 - Issue 9 - p 32–39

doi: 10.1097/01.NPR.0000452978.99676.2b

Symptoms, Diagnosis and Treatment - American Lung Association. (n.d.). Retrieved February 20, 2015, from http://www.lung.org/lung-disease/copd/about-copd/symptoms-diagnosis-treatment.html

How to say good-bye to acute bronchitis?

Tightness at chest

Shortness of breath

Coughing like you are coughing your lungs out.

Need your inhalers to open up your airway.

Thank you for following my blog.  As you can recall, I had a battle with my acute bronchitis at the beginning of the quarter.  Because of my thick yellow phlegm and unstoppable cough that lasted for more than two weeks in addition to intermittent asthma attack at night, I received an antibiotic, erythromycin, an antitussive (cough suppressant), promethazine/codeine syrup, and an inhaler, albuterol, were prescribed to me.  Although this is not the highly recommended course of treatment for acute bronchitis, this is the common treatment.  Acute bronchitis is usually a viral infection, you would not treat a virus with antibiotics.  However, between 65 to 80% of the patients received it.  Studies have shown that antibiotics such as erythromycin, doxycycline, trimethoprim-sulfamethoxazole would only decreased the symptoms by a fraction of a day.  It is used mainly for decreasing transmission.  This is a bit shocking to me since I thought my antibiotics were effective.  I guess it was more like a placebo.  I have a history of asthma so when I cough, I always feel like coughing my lungs out.  Cough suppressant and beta2- agonist are found to be beneficial for coughing episodes for both acute and chronic bronchitis.  Nevertheless, they are for short-term use only.  There is no evidence to support the use of inhaled or injection of coritcosteroid to be effective in acute bronchitis treatment.  The bottom line is take your medications as directed and do not end of course of treatment without your provider's approval.  Usually the treatment for bronchitis has minimal side effects.  Possible side effects of antibiotics include diarrhea, nausea, and/or vomiting.  Notify your provider immediately if you have dark urine, persistent nausea/vomiting new signs of infection, and unusual tiredness.  Common side effects for cough syrup with codeine include:  blurred vision, constipation, dizziness, drowsiness, and dry mouth.  You should seek medical help ASAP if you experience allergic reaction (e.g. rash, hives, itchiness, difficulty breathing), agitation, abnormal thoughts, changes in the amount of urine produced, confusion, irregular heartbeat, etc.  You should stop your medication if you experience any of the uncommon side effects and seek medical help right away.  Or else, finish your treatment as directed.              

Reference:
Blush, R. (2013). Acute bronchitis: Evaluation and management. The Nurse Practitioner, 38(10), 14-20.
Promethazine/codeine syrup: Indications, Side Effects, Warnings - Drugs.com. (n.d.). Retrieved February 14, 2015, from http://www.drugs.com/cdi/promethazine-codeine-syrup.html

Smoking my life away...

After reading my posts from the previous weeks, you should have a basic idea of what acute bronchitis and chronic bronchitis are.  Have you ever thought of having all the symptoms such as shortness of breath, tightness at chest, wheezing, coughing nonstop, and asthma attacks due to complications can lead you to death?  Let's picture the air bubbles (air sacs) in your lungs are so inflamed that you feel like your lungs would explode.  The follow video clip shows someone's confession about their personal progression with COPD by singing.

Next, let's check out another testimony of how someone lives with COPD (chronic bronchitis).

Let's review the symptoms of COPD and learn to manage it.

This is how your lungs will look when you have COPD.

Let's think twice before you pick up your next cigarette!